[Preliminary study of human serum albumin level in early warning onset of preeclampsia].

Objective: To observe the dynamic changes of human serum albumin (HSA) level during pregnancy and study the early warning significance of HSA level on the onset of preeclampsia (PE) . Methods: Totally 369 PE pregnant women (PE group) and 309 normal pregnant women (control group) without PE who admitted in Haidian Maternal and Child Health Hospital from January 2013 to December 2017 were selected. HSA levels were tested before meeting the criterion of PE in the first trimester, the early-third trimester and the late-third trimester, the difference between the two groups were compared. The relationship between the HSA level and the incidence of complications in PE patients was analyzed. Results: (1)The mean values of HSA level in PE group and control group were (41.9±3.1) versus (40.0±2.2) g/L, (34.2±2.7) versus (35.4±2.7) g/L and (33.7±2.9) versus (36.7±3.3) g/L in the first trimester,the early-third trimester and the late-third trimester respectively,the difference in the first trimester was no significance (P>0.05), while the differences in the early-third trimester and the late-third trimester were both significant (all P<0.05). (2) The HSA level during pregnancy of PE group showed a continuous downward trend, while the control group was V-shaped trend. The receiver operating characteristic (ROC) curve analysis showed that PE could be early warned by the decrease of HSA level in PE group [area under curve (AUC)=0.742, cut-off value=5.97 g/L, sensitivity 70.8%, specificity 62.8%], the same result was in severe PE (AUC=0.756, cut-off value=6.85 g/L, sensitivity 70.8%, specificity 72.0%). The level of HSA was negatively correlated with the incidence of complications (r=-0.19, P<0.01). Conclusions: Excessive decrease of HSA level is an early warning factor for PE onset. The higher the baseline of HSA level and the greater the extent of pregnancy decline, the risk of PE in pregnant women is higher. The lower of HSA level in PE, the incidence of complications is higher. The excessive decrease of HSA level may be the first clinical manifestation before the onset of clinical symptoms of PE, so it may be the warning factor and one of the laboratory indicators in the PE sub-clinical stage.目的： 分析妊娠期血清白蛋白（HSA）水平的动态变化，探讨HSA在子痫前期（PE）发病前的预警意义。 方法： 收集2013年1月至2017年12月于北京市海淀区妇幼保健院收治的PE孕妇369例（其中重度PE者233例）为PE组，同期309例正常孕妇为正常对照组。两组孕妇均于妊娠11~13周(+6)（妊娠早期）、妊娠28~32周（妊娠晚期前期）、妊娠35~37周（妊娠晚期后期）检测血清HSA水平，以分析PE孕妇妊娠各期HSA水平的变化，并分析PE临床发病后HSA水平与并发症发生率的相关性。 结果： （1）PE组孕妇妊娠早期、妊娠晚期前期、妊娠晚期后期的HSA水平分别为[（41.9±3.1）、（34.2±2.7）、（33.7±2.9）g/L]，正常对照组为[（40.0±2.2）、（35.4±2.7）、（36.7±3.3）g/L]；PE组孕妇妊娠早期的HSA水平较正常对照组高，PE组孕妇妊娠晚期前期、妊娠晚期后期的HSA水平分别较正常对照组低，分别比较，差异均有统计学意义（P均<0.01）。（2）PE组孕妇的妊娠期HSA水平变化呈持续下降趋势，正常对照组则呈"V"形趋势；HSA水平下降的幅度对预警PE的受试者工作特征曲线下面积（ROC-AUC）为0.742(界值为5.97 g/L，敏感度为70.8%，特异度为62.8%)，预警重度PE的ROC-AUC为0.756(界值为6.85 g/L,敏感度为70.8%，特异度为72.0%)。PE孕妇临床发病后，HSA水平与并发症的发生率呈负相关（r=-0.19，P<0.01）。 结论： 妊娠期HSA水平过度下降是发生PE的预警因素；HSA的基础水平越高、妊娠期下降的幅度越大时，孕妇发生PE的风险增加。PE孕妇发病后的HSA水平越低，其并发症的发生率越高。HSA水平过度下降可能是PE的预警因素及PE亚临床阶段实验室变化指标之一。.